Page 7 - 04- Celiac Disease

Repeat esophagogastroduodenoscopy if no clinical response to GFD or relapse in symptoms
(1)[C].
Follow anti-tTG IgA or deaminated antigliadin antibodies as a measure of
response/compliance with diet (vs. antigliadin IgA or IgG).

DIET
Remove gluten: wheat, rye, barley, and products with gluten additives (processed food/meat,
medications, hygiene products).
Dietary change is challenging (especially identifying sources of “hidden” gluten) and should
be coordinated with a skilled registered dietitian.

PATIENT EDUCATION
Discuss how to recognize gluten in various products.
Highlight potential complications and outcomes of failing to follow a GFD.
Support groups and self-education
Celiac Disease Foundation: https://www.celiac.org/; Quick start GFD guide for celiac disease
and non-celiac gluten sensitivity. https://celiac.org/wp-content/uploads/2013/12/quick-start-
guide.pdf
National Celiac Association: https://nationalceliac.org/
Beyond Celiac: https://www.beyondceliac.org/

PROGNOSIS
Good prognosis if adherent to GFD
Patients should see improvement within 7 days of dietary modification.
Symptoms usually resolve in 4 to 6 weeks.
It is unknown whether strict dietary adherence decreases cancer risk.
COMPLICATIONS
Malignancy: Untreated and refractory patients have increased cancer risk, but successful
treatment decreases risk to population baseline (1)[C].
Refractory disease (rare ~1–2% of all patients)
– May respond to prednisone
– May need total parenteral nutrition
Osteoporosis
Dehydration
Electrolyte depletion

REFERENCES

1. Rubio-Tapia A, Hill ID, Kelly CP, et al; for American College of Gastroenterology. ACG
clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol.
2013;108(5):656–676; quiz 677.
2. Riddle MS, Murray JA, Porter CK. The incidence and risk of celiac disease in a healthy US
adult population. Am J Gastroenterol. 2012;107(8):1248–1255.
3. Rubio-Tapia A, Ludvigsson JF, Brantner TL, et al. The prevalence of celiac disease in the
United States. Am J Gastroenterol. 2012;107(10):1538–1544; quiz 1537, 1545.
4. Freeman H. Celiac disease: a disorder emerging from antiquity, its evolving classification and
risk, and potential new treatment paradigms. Gut Liver. 2015;9(1):28–37.